Legg-Calvé-Perthes 病早期股骨头畸形的危险因素：MR 对比增强和弥散指数。
Risk Factors for Femoral Head Deformity in the Early Stage of Legg-Calvé-Perthes Disease: MR Contrast Enhancement and Diffusion Indexes.
机构信息
From the Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Korea (W.J.Y., I.H.C., T.J.C., W.J.); Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea (C.Y.C., M.S.P.); Department of Orthopaedic Surgery, Gacheon University Gil Hospital, Incheon, Korea (E.S.C.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea (J.E.C.).
出版信息
Radiology. 2016 May;279(2):562-70. doi: 10.1148/radiol.2015151105. Epub 2015 Nov 25.
PURPOSE
To determine whether changes in diffusion and/or contrast enhancement are of prognostic value in the early stage of Legg-Calvé-Perthes disease (LCPD).
MATERIALS AND METHODS
This study was approved by the institutional review board, and written informed consent was obtained from patient parents. Diffusion and contrast agent-enhanced magnetic resonance (MR) imaging studies were performed in 46 children (37 boys and nine girls; mean age, 7.5 years [age range, 3.3-11.9 years]) with unilateral LCPD at the early stage before development of extensive femoral head deformity. The degree of contrast enhancement was measured on the contrast-enhanced MR images, and the apparent diffusion coefficient (ADC) value was measured on the ADC map at various regions of interest in the proximal femur. The association of the MR imaging parameters that compared the affected side with the contralateral normal side with the femoral head deformity index value above 0.3 at 2 years was investigated.
RESULTS
Increased diffusion in the metaphysis (P = .003) and decreased contrast enhancement in the central epiphysis (P = .034) were the significant prognostic indicators of subsequent femoral head deformation. ADC in the metaphysis 45% higher and a contrast enhancement in the central epiphysis 37% lower than those of the contralateral normal side are associated with a nonfavorable prognosis. For diffusion MR imaging, sensitivity was 83% (15 of 18), specificity was 86% (24 of 28), positive predictive value was 79% (15 of 19), negative predictive value was 89% (24 of 27), and accuracy was 85% (39 of 46). For contrast-enhanced MR imaging, sensitivity was 78% (14 of 18), specificity was 64% (18 of 28), positive predictive value was 58% (14 of 24), negative predictive value was 82% (18 of 22), and accuracy was 70% (32 of 46).
CONCLUSION
Diffusion and contrast-enhanced MR imaging are potentially useful to assess risk of later development of femoral head deformity.
目的
旨在确定在 Legg-Calvé-Perthes 病（LCPD）早期阶段，弥散和/或对比增强变化是否具有预后价值。
材料与方法
本研究经机构审查委员会批准，并获得了患儿家长的书面知情同意。对 46 例单侧 LCPD 患儿（37 名男孩和 9 名女孩；平均年龄 7.5 岁[年龄范围 3.3-11.9 岁]）进行了弥散和对比增强磁共振成像（MR）检查，这些患儿均处于尚未出现广泛股骨头变形的早期阶段。在对比增强 MR 图像上测量增强程度，并在近端股骨的各种感兴趣区域的 ADC 图上测量表观弥散系数（ADC）值。研究了比较患侧和对侧正常侧的 MR 成像参数与 2 年后股骨头畸形指数值大于 0.3 的相关性。
结果
骺骨弥散增加（P =.003）和中央骨骺对比增强减少（P =.034）是随后股骨头变形的显著预后指标。骺骨 ADC 比对侧正常侧高 45%，中央骨骺对比增强比对侧正常侧低 37%，与预后不良相关。对于弥散 MRI，敏感性为 83%（15/18），特异性为 86%（24/28），阳性预测值为 79%（15/19），阴性预测值为 89%（24/27），准确性为 85%（39/46）。对于对比增强 MRI，敏感性为 78%（14/18），特异性为 64%（18/28），阳性预测值为 58%（14/24），阴性预测值为 82%（18/22），准确性为 70%（32/46）。
结论
弥散和对比增强 MRI 可能有助于评估股骨头变形后期发展的风险。
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